It never works. The People Mover breaks down more often than it's running, it seems, especially when the weather is (a) windy (b) snowy (c) rainy or (d) overcast. This is spring in Indiana, O Best Beloved. We average one day of sunshine a week.
The People Mover was broken this morning, occasioning the need for us to carpool out to the hospital for the first session of our Medicine-Neuro-Psych Intersession, second day. I hitched a ride with Lindy (how can someone so small, soft-spoken and sweet intimidate me so much?), Michelle and a new kid named Mike. I was social and chatted, even went and got chai when the others got coffee; burned my tastebuds off my tongue. "I should've ordered it only lava-hot," Mike comments, blowing into the tiny hole in the plastic top on his earth-toned paper cup.
We drank chai and coffee and talked with the others. I complained about my OB evaluation; I was commiserated by several others who noted that high test scores had been similarly non-rewarded by the staff, even with the addition of positive comments from reviewers. It seems you simply don't high-pass OB without working with particular staff and impressing them. It made me feel better, as did the e-mail stating that my request for more information (I wrote a lovely letter, O Best Beloved) would be passed on to the appropriate staff.
We broke into groups of three and saw our standardized patients. Was the exercise hard? No, not really. But the patients...
I volunteered to go second, my most comfortable position. We all went in to watch, but only one spoke. When I wasn't talking, I practiced sitting still and listening and not letting my mind wander. It was as difficult as always, but made less so by the difficulty of the situation, and my own inner desire to get everything I could from it.
First patient: You have just finished working up a woman for alcoholic pancreatitis. Her spouse has asked to speak with you in the quiet room. And he was so very good at his task, trying to get us to find a way to get treatment for this woman, this woman whose drinking was destroying the marriage and children, for whom he was covering, this woman who didn't want to join AA. But Pete found the in, found a way to bring camaraderie and offer hope, and I only hope psychiatry will teach me as much as it clearly taught him.
Second patient: Ms. B has just come to see you with complaints of insomnia, losing weight, and fatigue. Depression is a kicker - and for me, a frustrating encounter because I just don't deal well with people who don't mirror anything back at me. I get the gestalt quite quickly...then I have to make conversation, try to find out the little details. I require emotion to play off of, and when someone is truly so flat I find myself thinking I'm falling flat as well. Took a long time to get the information I think I should've gotten earlier.
Third patient: Ms. F is here for a follow-up visit for alcoholic pancreatitis. The creaky old black lady was a heckofan actress. Ms. F was an old-timer, who "only" drank 10-11 beers a night, and "only beer," drove a schoolbus and called in hung-over at least once a week, whose whole life revolved around her drinking buddies. Convince this woman that she has a drinking problem. Not happening. She can quit any time she likes, she quit for three weeks once to please her husband, who later divorced her because of her drinking, but he's no good anyway, and would-you-sign-this-back-to-work-release-n
All three patient encounters ended with a chance for us to get real feedback right away, something that is often overlooked in a clinical setting. Furthermore, we got feedback from the patient's perspective. It was a wonderful session, something to really challenge me and let me learn.
Carpooled back over to the med sci building, where we did an exercise on choosing our careers. It, like everything else I've done, only reaffirmed that my specialty choice is the right one. I completed a numerical self-assessment consisting of 18 1-10 scales. Then I ranked them in importance to me, 1-5. Then the program took the absolute value by which my score differed from the mean score of the respondents in each of thirty-some specialties, and it multiplied that by my importance ranking, and totalled it all up. Sort of a chi-square analysis, but not really.
My best match: Family Practice, with a total variation from the mean of 11.34, followed by Geriatric medicine, endocrinology, Pediatrics, Neurology, Nephrology, and Internal Medicine. Then Psych. The first surgical specialty was orthopedics at #15. My original goal upon deciding to go to medical school was forensic pathology - Pathology ranked second to last, with a variation of over 200, just above Diagnostic Radiology. Interestingly enough, Emergency Medicine (which I loved) was third from the bottom, and OB-GYN ranked below every other surgical specialty. Apparently, I'm better suited for Radiation Oncology than OB-GYN. I stuck my tongue out at the software, just to be petulant. I like babies.
Third session, after a lovely lunch at Qdoba all by myself (I should've gotten something with rice; I love their rice. Yet another reason you'll never see me on the Atkins diet, O Best Beloved; I can't stand the thought of giving up sushi and cilantro lime rice.) - third session was a review of those horrible Evidence-Based-Medicine searches we were supposed to do; mine which turned out - frustratingly - to not list the one article I wanted to find, which I obtained from another article's bibliography. She loved the search. She noted that the article I wanted had been catalogued under a different heading entirely, hence disabling me. She could find nothing else to comment on. Bother. I thought it sucked.
Met with my advisor. DeDe and I decided that I would indeed call my home doctor and set up an appointment to discuss my ADD and medicating it, before I enter crisis in October when I must be at my very sparkly-bestest for the Fort Wayne Family Practice Residency during my FP month. And I certainly need to know what to do before I do another OB month to scrub away that hideous black stain on my record. And she signed my elective papers, and hugged me. "I'm so proud of you. You've got everything lined up already. And you're so bright."
That, O Best Beloved, is the problem. It is neither arrogant nor grandiose of me to say that I am, in DeDe's words, bright. Even among my medical school colleagues, I have found ways to shine when I want to excel. I have a knack for catching things, learning on the fly, recalling tidbits of information. And I have been told time and time again that I am ahead of my class. I have always been bright, and until now I have been bright enough to compensate for my handicap, but now things are no longer repeated ten times. They are once-in-a-lifetime opportunities. I don't want to take meds. I cannot afford to let pride stand in the way of my future and the future of my patients. I do what I must.
I will be a good doctor.
I came back to an empty house, after shopping for groceries. I have killed my time quite admirably, O Best Beloved, going to Curves (212 on their scale, despite having a scrumptiously lovely weekend) and showering, writing about my day and completely ignoring anything productive I was going to do. I'll be productive later, during the rest of the rotation.
I start Pediatric Neurology tomorrow; the latest in a series of rotations apparently designed by myself to ensure that I don't get a whole lot of adult exposure while I prepare for an exam that will be almost entirely adult medicine. I don't know what I was thinking when I did this. I have, however, survived thus far. And I do adore the children's hospital, and the nurses there may be willing to let me do a bit of procedural business...perhaps even putting NG tubes in.
It's 2325, and I need to be on campus at 0800 tomorrow. Custom dictates six hours of sleep; that seems to be enough that I don't drag all day and yet not so much that I can't wake up in the morning. I should read my Pearls and get ready to face Neuro. Did I mention I hate Neuro, O Best Beloved?